Skip to main content
SpringerLink
Log in

Efficiency determinants and capacity issues in Brazilian for-profit hospitals

  • Published:
Health Care Management Science Aims and scope Submit manuscript

Abstract

This paper reports on the use of different approaches for assessing efficiency of a sample of major Brazilian for-profit hospitals. Starting out with the bootstrapping technique, several DEA estimates were generated, allowing the use of confidence intervals and bias correction in central estimates to test for significant differences in efficiency levels and input-decreasing/output-increasing potentials. The findings indicate that efficiency is mixed in Brazilian for-profit hospitals. Opportunities for accommodating future demand appear to be scarce and strongly dependent on particular conditions related to the accreditation and specialization of a given hospital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. World Health Organization 2011: site http://apps.who.int/ghodata/?theme=country#. Access in 09/12/2012.

  2. World Health Organization 2011: site http://apps.who.int/ghodata/?theme=country#. Access in 09/12/2012.

  3. Ministry of Health, DATASUS 2013: site http://cnes.datasus.gov.br/. Access in 05/08/2013.

  4. Ministry of Health, DATASUS 2013: site http://cnes.datasus.gov.br/. Access in 05/08/2013.

  5. Amil Assistência Médica Internacional S.A. site: http://www.amil.com.br/portal/institucional/empresa . Access in 05/08/2013.

References

  1. Ozcan YA, Lins ME, Lobo ME, Silva AC, Fiszman R, Pereira BB (2010) Evaluating the performance of Brazilian university hospitals. Ann Oper Res 178:247–261

    Article  Google Scholar 

  2. Guerra M, Souza A, Moreira D (2012) Performance analysis: a study using data envelopment analysis in 26 Brazilian hospitals. J Health Care Finance 38(4):19–35

    Google Scholar 

  3. Varela P, Pacheco R (2012) Federalism and health expenditures: competition and cooperation in the metropolitan region of São Paulo. Rev Contabilidade Finanças 23(59):116–127

    Article  Google Scholar 

  4. Proite A, Sousa M (2004) Eficiência técnica, economias de escala, estrutura da propriedade e tipo de gestão no sistema hospitalar brasileiro. In: Proceedings of the 32th Encontro Nacional de Economia, João Pessoa, Brazil

  5. Staat M (2006) Efficiency of hospitals in Germany: a DEA-bootstrap approach. Appl Econ 38:2255–2263

    Article  Google Scholar 

  6. Tiemann O, Schreyögg J (2009) Effects of ownership on hospital efficiency in Germany. BuR Bus Res 2(2):115–145

    Article  Google Scholar 

  7. Tiemann O, Schreyögg J (2012) Changes in hospital efficiency after privatization. Health Care Manag Sci 15(4):310–326

    Article  Google Scholar 

  8. Simar L, Wilson PW (1998) Sensitivity analysis of efficiency scores: how to bootstrap in nonparametric frontier models. Manag Sci 44(1):49–61

    Article  Google Scholar 

  9. Simar L, Wilson PW (2004) Performance of the bootstrap for DEA estimators and iterating the principle. In: Cooper WW, Seiford LM, Zhu J (eds) Handbook on data envelopment analysis. Kluwer Academic Publishers, Boston, pp 265–298

    Google Scholar 

  10. Hollingsworth B, Dawson PJ, Maniadakis N (1999) Efficiency measurement of health care: a review of non-parametric methods and applications. Health Care Manag Sci 2(3):161–172

    Article  Google Scholar 

  11. O’Neill L, Rauner M, Heidenberger K, Kraus M (2008) A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socio Econ Plan Sci 42:158–189

    Article  Google Scholar 

  12. Ozcan YA (2008) Health care benchmarking and performance evaluation: an assessment using data envelopment analysis (DEA). Springer, Newton

    Book  Google Scholar 

  13. Hofmarcher MM, Paterson I, Riedel M (2002) Measuring hospital efficiency in Austria: a DEA approach. Health Care Manag Sci 5(1):7–14

    Article  Google Scholar 

  14. Athanassopoulos A, Gounaris C (2001) Assessing the technical and allocative efficiency of hospital operations in Greece and its resource allocation implications. Eur J Oper Res 133:416–431

    Article  Google Scholar 

  15. Kontodimopoulos N, Nanos P, Niakas D (2006) Balancing efficiency of health services and equity of access in remote areas in Greece. Health Policy 76:49–57

    Article  Google Scholar 

  16. Falavigna G, Ippoliti R, Manello A (2012) Hospital organization and performance: a directional distance function approach. Health Care Manag Sci. doi:10.1007/s10729-012-9217-8

    Google Scholar 

  17. Ancarani A, Di Mauro C, Giammanco MD (2009) The impact of managerial and organizational aspects on hospital wards’ efficiency: evidence from a case study. Eur J Oper Res 194:280–293

    Article  Google Scholar 

  18. Helmig B, Lapsley I (2001) On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study. Heal Serv Manag Res 14(4):263–274

    Article  Google Scholar 

  19. Tiemann O, Schreyögg J, Busse R (2012) Hospital ownership and efficiency: a review of studies with particular focus on Germany. Health Policy 104:163–171

    Article  Google Scholar 

  20. Caballer-Tarazona M, Moya-Clemente I, Vivas-Consuelo D, Barrachina-Martínez I (2010) A model to measure the efficiency of hospital performance. Math Comput Model 52:1095–1102

    Article  Google Scholar 

  21. Navarro-Espigares JL, Torres EH (2011) Efficiency and quality in health services: a crucial link. Serv Ind J 31(3):385–403

    Article  Google Scholar 

  22. Biorn E, Hagen TP, Iversen T, Magnussen J (2003) The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores 1992–2000. Health Care Manag Sci 6(4):271–283

    Article  Google Scholar 

  23. Linna M, Häkkinen U, Magnussen J (2006) Comparing hospital cost efficiency between Norway and Finland. Health Policy 77:268–278

    Article  Google Scholar 

  24. Barros CP, Menezes AG, Peypoch NP, Solonandrasana B, Vieira JC (2008) An analysis of hospital efficiency and productivity growth using the Luenberger indicator. Health Care Manag Sci 11:373–381

    Article  Google Scholar 

  25. Barros CP, Menezes AG, Vieira JC (2013) Measurement of hospital efficiency using a latent class stochastic frontier model. Appl Econ 45(1):47–54

    Article  Google Scholar 

  26. Ersoy K, Kavuncubasi S, Ozcan YA, Harris JM (1997) Technical efficiencies of Turkish hospitals: DEA approach. J Med Syst 21(2):67–74

    Article  Google Scholar 

  27. Sahin I, Ozcan YA (2000) Public sector hospital efficiency for provincial markets in Turkey. J Med Syst 24(6):307–320

    Article  Google Scholar 

  28. Sahin I, Ozcan YA, Ozgen H (2011) Assessment of hospital efficiency under health transformation program in Turkey. CEJOR 9(1):19–37

    Article  Google Scholar 

  29. Wang S, Ma Q, Guan Z (2007) Measuring hospital efficiency in China using grey relational analysis and data envelopment analysis. Grey Systems and Intelligent Services, 2007. GSIS 2007. IEEE International Conference on: 135–139. 18–20 Nov. 2007. doi::10.1109/GSIS.2007.4443252

  30. Ng YC (2011) The productive efficiency of Chinese hospitals. China Econ Rev 22(3):428–439, Elsevier

    Article  Google Scholar 

  31. Agarwal S, Yadav SP, Singh SP (2006) Assessment of relative efficiency of private sector hospitals in India. J Math Syst Sci 2(1):1–22

    Google Scholar 

  32. Srinivasan R (2009) Healthcare in India vision 2025, issue and prospects. Planning Commission, Government of India

  33. Ramanathan TV, Chandra KS, Thupeng WM (2003) A comparison of the technical efficiencies of health districts and hospitals in Botswana. Development Southern Africa 20(2):307–320

    Google Scholar 

  34. Jandaghi G, Matin HZ, Doremami M, Aghaziyarati M (2010) Efficiency evaluation of Qom public and private hospitals using data envelopment analysis. Eur J Econ Finance Adm Sci 22:83–92

    Google Scholar 

  35. Shahhoseini R, Tofighi S, Jaafaripooyan E, Safiaryan R (2011) Efficiency measurement in developing countries: application of data envelopment analysis for Iranian hospitals. Heal Serv Manag Res 24:75–80

    Article  Google Scholar 

  36. Su S, Lai M, Huang H (2009) Healthcare industry value creation and productivity measurement in an emerging economy. Serv Ind J 29(7):963–975

    Article  Google Scholar 

  37. Gonçalves AC, Noronha CP, Lins M, Almeida R (2007) Análise envoltória de dados na avaliação de hospitais públicos nas capitais brasileiras. Rev Saúde Pública 41(3):427–435

    Article  Google Scholar 

  38. Lobo MSC, Ozcan YA, Silva ACM, Lins MPE, Fiszman R (2009) Financing reform and productivity change in Brazilian teaching hospitals: Malmquist approach. Cent Eur J Oper Res. doi:10.1007/s10100-009-0097-z

    Google Scholar 

  39. Varela P, Martins G (2011) Efficiency of primary health care spending by municipalities in the metropolitan region of São Paulo: a comparative analysis of DEA models. Rev Bus 32(1):17–34

    Google Scholar 

  40. Hollingsworth B (2003) Non-parametric and parametric applications measuring efficiency in health care. Health Care Manag Sci 6:203–218

    Article  Google Scholar 

  41. Hollingsworth B (2008) The measurement of efficiency and productivity of health care delivery. Heal Econ 17:1107–1128

    Article  Google Scholar 

  42. Lee K-H, Yang S-B, Choi M (2009) The association between hospital ownership and technical efficiency in a managed care environment. J Med Syst 33:307–315

    Article  Google Scholar 

  43. Burgess JF, Wilson PW (1996) Hospital ownership and technical inefficiency. Manag Sci 42(1):110–123

    Article  Google Scholar 

  44. Hu H-H, Qi Q, Yang C-H (2012) Analysis of hospital technical efficiency in China: effect of health insurance reform. China Econ Rev. doi:10.1016/j.chieco.2012.04.008

    Google Scholar 

  45. Hu J-L, Huang Y-F (2004) Technical efficiencies in large hospitals: a managerial perspective. Int J Manag 21(4):506–513

    Google Scholar 

  46. Chang H, Cheng M-A, Das S (2004) Hospital ownership and operating efficiency: evidence from Taiwan. Eur J Oper Res 159:513–527

    Article  Google Scholar 

  47. Grosskopf S, Margaritis D, Valdmanis V (2004) Competitive effects on teaching hospitals. Eur J Oper Res 154:515–525

    Article  Google Scholar 

  48. Rahman M (2006) Measuring and explaining the managerial efficiency of private medical clinics in Bangladesh: an exploratory study. Thesis. Brandeis University

  49. Groff J, Lien D, Su J (2007) Measuring efficiency gains from hospital mergers. Res Healthc Financ Manag 11(1):77–90

    Google Scholar 

  50. Wei C-K, Chen L, Li R, Tsai C, Huang H (2012) A study of optimal weights of data envelopment analysis: development of a context-dependent DEA-R model. Expert Syst Appl 39:4599–4608

    Article  Google Scholar 

  51. Alexander J, Wheeler J, Nhara T, Lemak C (1998) Managed care and technical efficiency in outpatient substance abuse treatment units. J Behav Heal Serv Res 25(4):377–396

    Article  Google Scholar 

  52. Lee K-H, Chun K, Lee J (2008) Reforming the hospital service structure to improve efficiency: urban hospital specialization. Health Policy 87:41–49

    Article  Google Scholar 

  53. Charnes A, Cooper WW, Rhodes E (1978) Measuring efficiency of decision making units. Eur J Oper Res 2(6):429–444

    Article  Google Scholar 

  54. Bazargan M, Vasigh B (2003) Size versus efficiency: a case study of US commercial airports. J Air Transp Manag 9(3):187–193

    Article  Google Scholar 

  55. Zhu J (2003) Quantitative models for performance evaluation and benchmarking: data envelopment analysis with spreadsheets and DEA excel solver. Springer, New York

    Book  Google Scholar 

  56. Mogha SK, Yadav SP, Singh SP (2012) Performance evaluation of Indian private hospitals using DEA approach with sensitivity analysis. Int J Adv Manag Econ 1(2):1–12

    Google Scholar 

  57. Adler N, Berechman J (2001) Measuring airport quality from the airlines’ viewpoint: an application of data envelopment analysis. Transp Policy 8(3):171–181

    Article  Google Scholar 

  58. Cooper WW, Li S, Seiford LM, Thrall RM, Zhu J (2001) Sensitivity and stability analysis in DEA: some recent developments. J Product Anal 15(3):217–246

    Article  Google Scholar 

  59. Barros CP, Gonçalves O, Peypoch N (2012) French regional public airports technical efficiency. Int J Transp Econ 39(2):255–274

    Google Scholar 

  60. Jenkins L, Anderson L (2003) A multivariate statistical approach to reducing the number of variables in data envelopment analysis. Eur J Oper Res 147(1):51–61

    Article  Google Scholar 

  61. Nadimi R, Jolai F (2008) Joint use of Factor Analysis (FA) and Data Envelopment Analysis (DEA) for ranking of data envelopment analysis. Int J Math Phys Eng Sci 2(4):218–222

    Google Scholar 

  62. Adler N, Yazhemsky E (2005) Improving discrimination in data envelopment analysis: PCA-DEA versus variable reduction. Which method at what cost? http://pluto.huji.ac.il/~msnic/1W.pdf. Accessed 09 December 2012

  63. Allen R, Athanassopoulos A, Dyson RG, Thanassoulis E (1997) Weights restrictions and value judgements in data envelopment analysis: evolution, development and future directions. Ann Oper Res 73:13–34

    Article  Google Scholar 

  64. Adler N, Golany B (2007) PCA-DEA. In: Zhu J, Cook W (eds) Modeling data irregularities and structural complexities in data envelopment analysis. Springer, New York, pp 139–153

    Chapter  Google Scholar 

  65. Kordrostamia S, Amirteimoori A, Masoumzadeh A (2011) Evaluating the efficiency of DMUs with PCA and an application in real data set of Iranian banks. Int J Ind Math 3(4):251–258

    Google Scholar 

  66. Tabachnick BG,Fidell LS (2001). Using multivariate statistics. Allyn and Bacon, Boston

  67. Cesaro L, Marongiu S, Arfini F, Donati M, Capelli MG (2009) Methodology for analyzing competitiveness, efficiency and economy of scale. Use and applications of DEA. FACEPA Deliverable D5.1.3 (April). http://www.ekon.slu.se/facepa. Accessed 09 December 2012

  68. Curi C, Gitto G, Mancuso P (2011) New evidence on the efficiency of Italian airports: a bootstrapped DEA analysis. Socio Econ Plan Sci 45(2):84–93

    Article  Google Scholar 

  69. Banker RD (1993) Maximum likelihood, consistency and DEA: a statistical foundation. Manag Sci 39(10):1265–1273

    Article  Google Scholar 

  70. Simar L, Wilson PW (2007) Estimation and inference in two-stage, semi-parametric models of production processes. J Econ 136(1):31–64

    Article  Google Scholar 

  71. Simar L, Wilson PW (2008) Statistical inference on nonparametric frontier models: recent developments and perspectives. In: Fried HO, Lovell CAK, Schmidt SS (eds) The measurement of productive efficiency and productivity growth. Oxford University Press, New York, pp 421–521

    Google Scholar 

  72. Cooper WW, Seiford LM, Tone K (2007) Data envelopment analysis: a comprehensive text with models, applications, references and DEA-solver software. Springer, New York

    Google Scholar 

  73. Kumbhakar SC, Lovell CA (2003) Stochastic frontier analysis. Cambridge University Press, Cambridge

    Google Scholar 

  74. Barr R (2004) DEA software tools and technology—a state-of-the-art survey. In: Cooper WW, Seiford L, Zhu J (eds) Handbook on data envelopment analysis. Kluwer Academic Publishers, Boston

    Google Scholar 

  75. Bogetoft P, Otto L (2010) Benchmarking with DEA, SFA, and R. Springer, New York

    Google Scholar 

  76. Wanke PF (2012) Efficiency of Brazil’s airports: evidences from bootstrapped DEA and FDH estimates. J Air Transp Manag 23:47–53

    Article  Google Scholar 

  77. Thanassoulis E (2001) Introduction to the theory and application of data envelopment analysis. Springer, New York

    Book  Google Scholar 

  78. Coelli T (1996) A guide to DEAP version 2.1: a data envelopment analysis (computer) program. Accessed at http://www.une.edu.au/econometrics/cepa.htm

  79. Wanke PF, Barbastefano RG, Hijjar MF (2011) Determinants of efficiency at major Brazilian port terminals. Transp Rev 31(5):653–677

    Article  Google Scholar 

  80. Odeck J, Alkadi A (2001) Evaluating efficiency of the Norwegian bus industry using data envelopment analysis. Transportation 28:211–232

    Article  Google Scholar 

  81. Cullinane K, Wang T, Song D, Ji P (2006) The technical efficiency of container ports: comparing data envelopment analysis and stochastic frontier analysis. Transp Res A 40:354–374

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Studies in Healthcare Services, COPPEAD Graduate Business School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Cláudia Araújo

  2. Technical University of Lisbon, Lisbon, Portugal

    Carlos P. Barros

  3. Center for Studies in Logistics, Infrastructure and Management, COPPEAD Graduate Business School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Peter Wanke

Authors
  1. Cláudia Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos P. Barros
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Wanke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos P. Barros.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Araújo, C., Barros, C.P. & Wanke, P. Efficiency determinants and capacity issues in Brazilian for-profit hospitals. Health Care Manag Sci 17, 126–138 (2014). https://doi.org/10.1007/s10729-013-9249-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10729-013-9249-8

Keywords

Search

Navigation